MEDICARE: MR. MARCUS FRANK KLEMMT CPO, FAAOP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669471785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS FRANK KLEMMT CPO, FAAOP

Provider Business Mailing Address
First Line	:	130 OAKDALE ROAD
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790
Country	:	US
Telephone Number	:	607-770-4400
Fax Number	:	607-770-4422

Provider Business Practice Location Address
First Line	:	130 OAKDALE RD
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1758
Country	:	US
Telephone Number	:	607-770-4400
Fax Number	:	607-770-4422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/10/2007

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